Help! I Can’t Feel My Fingers!

Emmie asks: After running in the cold, my fingers get swollen, feel numb, and turn white. It seems to take forever for them to warm up. My running partner said it sounds like Raynaud’s. What is this and what precautions should I take?

This is the season for Raynaud’s Syndrome and your description fits the pattern. Raynaud’s is an overreaction of the body response to cold exposure. When confronted with cool or cold conditions, the small blood vessels in the skin normally contract or narrow down to decrease blood flow and preserve the body heat in the central core. Some people, more often women than men, react to cold exposure with very intense vasoconstriction, which cuts off the blood supply for a period of time. This is Raynaud’s. For very sensitive people, this can occur when grasping the milk jug from the refrigerator.

I think of the American flag—white, blue, and red—as the color cascade of Raynaud’s, although not everyone displays all the colors. The vasospasm usually affects fingers and toes, but can involve the nose, lips, ears, and nipples. The condition can be very painful and can last 15 minutes after the vasospasm relents. With repeated attacks, the blood vessels in the affected areas can thicken, changing the functional ability of the vessels. Some people also get this reaction from stress or emotional situations. For most people, Raynaud’s is a stand alone problem, but it can be associated with connective tissue diseases like rheumatoid arthritis, lupus, or Sjogren's syndrome, so it is worth a visit with your physician to exclude other problems. It is aggravated by tobacco use, repetitive finger use (typing or piano), and vibrating tool use.

If you have an attack, warm the affected areas by moving to a warmer area (indoors) and if possible, dip the affected parts in a warm water bath. You can also wiggle your fingers or toes, put your hands in your arm pits, or add more layers to your hands and trunk. If you are in the middle of a run, pick up your pace for a bit to increase internal heat production. Massaging the affected parts, like your hands and feet, may also help.

Why runners, and why in the fall and early winter? Coming off summer, it is easy to forget the gloves, hat, and extra layers that may be required to keep warm. If you have this problem, you will need to layer your clothing and stay warm throughout your run, especially as you are warming up. If you start warm and stay warm, the reaction is lessened or prevented. Sometimes this means running with sweaty hands or carrying your gloves or mittens for the latter part of your run. Keeping your head and trunk warm also helps. So a cap and running vest may provide the extra warmth early in your run to avoid the reaction. Again, you may have to unzip or “shed and carry” to avoid getting too warm later in your run.

I have been plagued with this since my early 20s. I need gloves when others do not, and I need mittens when others get by with gloves. I always (almost) have gloves in my jacket pockets after Labor Day and usually wear a hat. I sometimes use a “warm water—cold air” exposure technique that I learned early in my career to condition my hands. On a cool day, take a pail of warm water out on the porch and alternate exposing your hands to the cool air and then dip them in the warm water at about five-minute intervals. That seems to lessen the frequency and intensity of attacks.

There are also medications that help this condition by dilating blood vessels. Most are used to treat other conditions. So if you have other medical problems, it may be possible to kill two birds with one stone. In people with no other problems, I generally use nifedipine or diltiazem in the lowest dose that prevents the symptoms, and often only for the cold parts of the year. Your physician can help you find the medication that works best for you.

Raynaud’s deserves respect as the limited blood flow to the affected area can be a set up for frostbite when it is below freezing. This can be a critical issue if you are running in very cold conditions on routes with no warming huts or places to find warm shelter. Carrying a packet of hand warmers on these runs could be very helpful if you have a severe attack. If you have severe attacks, it may be prudent to plan your routes with places to warm up or to stay indoors when you know it is too cold for you.

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